My Three Shrinks

June 10, 2007: Dr. Phil on Skype Topics include: * Genetics of Cocaine-Induced Paranoia. Roy talks about a recent article in Biological Psychiatry by Kalayasiri which suggests that a particular mutation (C1021T) in the dopamine beta-hydroxylase (DBH) gene was associated with significantly increased paranoia in a small group of cocaine abusers. Genetics is playing an increasing role in understanding how we respond to drugs AND to our environment. * Dinah wins an award for her writing. * Expectation vs Evidence-based Medicine. We get into a detailed discussion about how patients' perceptions and expectations get in the way of evidence-based medicine (with examples from Flea's post on admitting children and direct-to-consumer advertising). "Doc, my friend got better with DrugX so I want to try it." "It goes back to 'who deserves care'." * Dr. Phil visits My Three Shrinks. THIS IS A MUST-LISTEN SEGMENT! Clink and I play a trick on Dinah by "calling" Dr. Phil on Skype and he "interviews" us. This is a riot!! Dinah is such a good sport. [link to DrPhil Soundboard] * Dark Tourism. After reading a NYT piece on touring prisons, Clink discusses the concept of dark tourism, where people seek out notorious sites to see (like cemeteries and prisons). She sent us a humongous scholarly piece on the subject (see Clink's Travelogue for more fun).Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 3, 2007 Topics include:# Doctor Anonymous to be guest on June 17 podcast. # Clink brings back notepads with loons on them and cinnamon lefse from the midwest.# Flea's medical blog affects his malpractice trial. This is a fascinating story, which is well-summarized and explained on Eric Turkewitz's legal blog. We're waiting for Flea's (Dr. Lindeman's) book to come out.# Dinah talks about transference. Also see prior post on Transference to the Blog.# Rules for Bloggers. In response to Flea's troubles, ClinicalCases suggests Five Rules for Blogging: 1-Write as if your boss and your patients are reading your blog every day 2-Comply with HIPAA 3-Do not blog anonymously. List your name and contact information 4-If your blog is work-related, it is probably better to let your employer know 5-Use a disclaimer# We mention a survey of medical bloggers that was done last year. Anyone have a link?# Movie Review: Away From Her. Clink thought this movie about a woman with dementia was very good.# Oh, remember... check out next week's podcast, when Dr. Phil will be joining us for a brief interview. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

May 27, 2007 Topics include: * Physician-Assisted Executions. The American Medical News had a story by Kevin B. O'Reilly about how some states are trying to force physicians to participate in executions. The ethics of such activities are debated. * Realizing the Promise of Pharmacogenomics. A draft federal report is available for public comment (by June 1) about the development of pharmacogenetics and the impact of genomic medicine on the future of health care. You can find the report and comment form here. "The report identifies a number of challenges for the development of pharmacogenomics and its effective integration into health care practice, including the need to improve the health-information infrastructure, to provide education and training for practitioners, and to maintain the confidence of all stakeholders by effectively addressing ethical, legal and social issues arising from pharmacogenomics." * Dopamine, Genetics, and Environmental Stressors in ADHD. As an example of the above, this month's Archives of General Psychiatry has an article by Manfred Laucht, et al., showing evidence of an interaction between a mutation in the Dopamine Transporter (DAT) gene and severe environmental stress (e.g., abuse) triggering symptoms of ADHD. Also mentioned in the podcast is data suggesting that certain Serotonin Transporter Promoter (5HTTP) mutations predict one's response to SSRI antidepressants, the development of side effects to these drugs, and the propensity to develop psychiatric symptoms. * Forced Outpatient Treatment in PA. Liz Spikol, who writes the blog and newspaper column, Trouble with Spikol, for the Philadelphia Weekly, writes about Pennsylvania Senate Bill 226, which would make it easier to make people with severe mental illness who are "unlikely to survive safely in the community without supervision." A long debate on the podcast ensues (half the 'cast) about the ethics and practicality of such tactics. * Don't miss Roy's telling of the official (according to psychologist, Richard Wiseman) funniest joke in the world (around the 25 minute mark). Just to be on the safe side, be sure you aren't driving when you listen to it.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

May 20, 2007: Topics include: # Intersex disorders: This is where one is born with ambiguous genitalia, and one is raised a gender which is different from one's genetic gender. It is a rare condition. Dr. Kraft discusses the many complications that this can cause. This is part of an answer to Zoe Brain's question, continued from last week's podcast. # What is a "mother"? A Maryland court has determined that a surrogate mother can have her name removed from a baby's birth certificate, like fathers have been capable of for years. Can a child be born with no parents on its birth certificate? See Show Notes for links to the King Missile song, Detachable Penis, on eMusic and YouTube. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

May 13, 2007: Topics include: # Happy Mother's Day! # Turkewicz law blog a hit with Clinkshrink. Her recommendations? Malpractice Primer and Economics. # Q&A: Zoe Brain asks "Is there a Standard of Care for GIDNOS in the case where the patient is intersexed? And does the degree of intersex affect the therapeutic regime, and if so, how? I'm familiar with the WPATH (Formerly HBIGDA) v6 SOC for GID. But once a diagnosis of GIDNOS is established, the SOC does not appear to apply."Answer: Huh? (We did the best we could.) Also, see Farmer v. Brennan. # APA says people with Medicare Part D having trouble getting their psychiatric medications. Also, discussion of the "donut hole." # Medical Truth in Advertising bill: Is your "doctor" really a doctor? # Ethical conundrums: trains and Tarasoffs and guns (oh my!). Also, Maryland's problematic law requiring reporting of childhood abuse, even if you are now 90 or you don't know who the perpetrator is. And, what do you do with a dead astronaut on the way to Mars? # If Dinah had Lost It in Space, she Wishes she would have a Crystal Ball. # A shrink like me? Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

Xanax Blues May 7, 2007: * Q&A: Emailing patients * Q&A: What is Psychiatry doing about asexuality? * Q&A: Talk about Munchausen's disease and Dissociative Identity Disorder (DID). * Is denying care malpractice? * California forensic psychiatry staffing problems * More troubles with Xanax Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

BRING YOUR OWN BRAINS May 1, 2007: This is our GRAND ROUNDS podcast. Check out this week's Grand Rounds post, containing 50 medicine-related posts from all corners of the blogosphere (actually, that would be a blogocube, wouldn't it?). I'm not even going to try to put everything here, but I will list the blogs that made submissions... A Chronic DoseAn American Medic in BritainAnxiety, Addiction and Depression TreatmentsClinical CasesDiabetes MineDr AnonymousDr Marc GreensteinDr Val and the Voice of ReasonEmergiblogEnoch ChoiER NurseyHealth Business BlogHealth PsychHealthLineHighlight HealthHospital ImpactInsureBlogInterested ParticipantKevin, M.D.Knocking From InsideLiverpool LeftoversMidwest Med Student Meets East Coast PoliticsMonash Medical StudentMovin' MeatNurse Ratched's PlaceNY Emergency MedicineNY Personal Injury LawyerOdysseys of GeorgeOne Version of ThingsPixelRNRachel's Wide Word of LunacyRickety Contrivances of Doing GoodScienceRollSharpBrainsSix Until MeTales of an Emergency Room NurseTangent 90 DegreesTech MedicineTeen Health 411The Blog That Ate ManhattanThe Differential: Medscape Med Students BlogsThe Doctor BloggerThe Fitness FixerThe Snarky GerbilThe Tangled NeuronTSCDUniversal HealthVitum MedicinusWandering VisitorSend us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

April 22, 2007: This podcast comes out the day after the 1-year anniversary of our blog. Thank you to all of our well-wishers. It's not always easy to keep something like this, and the podcast, going. But having friends like Dinah and Clink make it easy. Note that next week will be a special podcast, where we will discuss many of the submissions for our May 1 Grand Rounds. Send us your submissions by Saturday, April 28, 2007, at midnight at mythreeshrinksATgmailDOTcom. We'll even include some brief audio comments about your post (attach a 20-30 sec .m3). Topics include: # A lot of silly talk about our anniversary, gifts, ducks, and chocolate. # VIRGINIA TECH TRAGEDY. Most of the podcast is about this and related offshoots. We discuss some comments on Dinah's post, Unspeakable. We also point out two past posts, Suicidal Students and Let's Talk About Suicide. # This CBS News story discusses the struggle of BALANCING PRIVACY AND SAFETY on college campuses. # Dr. Michael Welner, a forensic psychiatrist consulting for ABC News, CRITICIZED THE MEDIA for showing the videotapes from Cho Seung-Hui (more here). (What is "Ismail Ax"?) # NAMI has some useful links related to this tragedy. # Clink lists OTHER BAD EVENTS which have happened in the third week of Aprils past, including things to do with Hitler, Lincoln, Oklahoma City, Waco, and Columbine. # There are two MENTAL HEALTH PARITY BILLS before congress. Please let your U.S. Representatives and Senators know you want these passed unamended. # Psychiatric News reports that the number of medical students choosing CAREERS IN PSYCHIATRY is holding steady at 1000 entering psychiatry residencies this summer.Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

April 17, 2007: ClinkShrink here. I volunteered to help Roy by editing one of our podcasts--heaven help me, I did the best I could. Be patient, I'm using Windows. This is podcast number 16 which was actually podcast number 14 taped about a month ago and taken out of order for no particular reason.Topics include: * First up are the TOP 25 CRIMES OF THE CENTURY, a topic that could only be mine. It's a Time article that lists some of the most infamous or unusual crimes, but I have a couple bones to pick about their choices. Roy and Dinah just think I'm weird for even knowing this stuff. [Listen in to find out Clink's favorite crime. -Roy] * Next we ANSWER A QUESTION from Driving Miss Molly regarding how much and what kind of preparations psychiatrists do before their patients' appointments. * Finally we do the Shrink Rap BLOG ROLLCALL, where Shiny Happy Person deals with medical training in the UK and under the NHS, Roy flirts with the Girl with the Blue Steth, and Intueri talks about bipolar disorder in kids. Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

April 8, 2007:Topics include:* Q&A: from Gerbil, who asks, "I'd love to hear your thoughts on treatment contracts. My specialty is self-injury, and I often give talks on this subject. Invariably, at least one of my attendees will share that he/she has clients agree that they will be discharged if they hurt themselves between sessions. I've heard others talk about making similar contracts regarding substance use, gambling, and other high-risk behaviors. This makes no sense to me--why make the goal of therapy the condition for receiving therapy? ... I was interested in your opinions, especially because of the settings in which you work." * Dinah rants about Insurance Companies. * Article on Mentally Ill Presidents from Mental Healthworks Newsletter. Nearly half have had mental illnesses. This leads into a discussion about the validity of doing psychological autopsies, or diagnosing someone without personal examination. The Goldwater Rule is discussed in this context (re: Presidents of The United States, or POTUS), as are the APA's Principles of Medical Ethics. * Who Reads Shrink Rap? Reader Poll Results: 20% are physicians (13% psychiatrists, 7% others); 9% nurses; 7% social workers; 7% psychologists; ~30% patients; and ~30% others. So more than one-third are mental health professionals, and close to one-half are health care professionals (nearly 200 readers voted). Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

April 1, 2007:Topics include: * Q&A: Midwife with a Knife, an OB/GYN, asks us about whether pedophilia is a disease or something else, and what we think about civil (as opposed to criminal) commitment for it. Clink uses one of her 50-cent words on us (ephebophilia, a term that Clink says was coined by John Money in his book, Love Maps). See also The Last Psychiatrist's posts on this here and here. * NYT article: "The Brain on the Stand", by Jeffrey Rosen. Clink talks about this article about brain diseases being put on trial to explain bad behavior. * Q&A: Dr Anonymous wants us to say more about our recent posts (here and here) on humor and medicine. This whole discussion (and the numerous comments on the blog) was started by Roy's lyrics to "Walk Like a Psychiatrist." Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

March 4, 2007: Topics include: * How does NASA handle psychiatric emergencies in space? The recent 'astronaut goes wild' headlines get us talking about NASA's procedures for handling acute psychotic breaks and suicidal behavior in space. Also, go to page 847 of the above-linked document to see the list of medications which are kept on the ISS (International Space Station). Listen to the podcast to find out which antidepressant is the SSRI of choice for NASA. * Q&A: Sandra, a prolific, Canadian Barbie Doll (it's true, look at her picture) from Omni Brain and NeuroFuture sent in a multi-part question: "Do you agree that neurological factors may diminish legal responsibility (but not excuse it) in ways not currently considered by the legal system, i.e., that don't fall in line with the McNaughton insanity defence, and the legal system should change in accordance? In what ways, based on what you see in the population you treat? Also, in cases like compulsive sexual offenders, do you support chemical castration and similar means of crime prevention?" This is obviously a Clinkshrink question, but we have a spirited discussion about these areas. Next week: Visitor survey; Top 25 crimes of the last century; What do psychiatrists do to prepare for the next session (thanks, DrivingMissMolly); NHS fiasco. Send us your questions at mythreeshrinksATgmailDOTcom.Last week's musical snippet was from Suzanne Vega's 1987 release of Language from the album, Solitude Standing. (Also, you've gotta check out this Tom's Diner-inspired I Dream of Jeannie video.) Go to http://mythreeshrinks.com for show notes with links.